Thanks complaints for a forum to expose the truth about Rip Off companies like Mid-West. Below is a letter meant I intend to send to a number of agencies. I am in the process of trying to determine if any of what has happened to me constitutes the legal definition of fraud in the state of California.in particular, the limits of this policy were not disclosed to me, I have never been notified that we have an old, outdated plan, I have not received a copy of the policy since we first enlisted 8 years ago, and it from what I am reading, our joining Alliance for Affordable Services did not actual constitute joining a group as was represented. I would appreciate any comments and opinions and suggestions.
My family and I have been the victims of a dishonest and unscrupulous insurance company, Mid-West National Life Insurance Co. Of TN (formally MegaLife) with devastating long term consequences we are now stuck in the middle of and can find no remedy for. Please let me explain.
I am 53 years old, self employed small business person struggling to survive. I have had to lay off 2 of my 4 employees and if things do not change for the better quickly, will be shutting down my business as well. My largest re-occurring out of pocket expense each month is for medical insurance. I have been self employed since 1983, and since the age of 23 have continually and without interruption maintained a health insurance policy for my family and myself. Other than the birth of our 3 children, a couple of broken bones and a few of outpatient procedures, we have not incurred any catastrophic/major medical costs, had any serious illnesses, etc. We maintained a healthy lifestyle, and were very careful to avoid any unnecessary doctors visits due to the out of pocket costs, which are typical for the kind of insurance small business people such as us can afford.
I had no real complaints with the policy if had prior to this one (Blue Cross), as I had the peace of mind to know that even though we paid quite a bit for the smaller, routine medical issues, in the event we needed the coverage for a major medical problem, it was in place with coverage. I have always worked hard to build and maintain a good reputation for the work I do, for paying my bills and making sure my families health needs were covered. This was and is a very important issue to me, and even more so with a wife and 3 children. I purchased life insurance at this time as well, again for the peace of mind knowing my family would have some financial resources to support them in the event I died, and out of a sense of responsibility to take care of those you care for.
In we started shopping for another health insurance company due to drastically rising premiums with the company we had been with for a number of years. I believe 3 kids in 6 years triggered this increase, but for whatever the reasons, we knew we had to search for an alternative. We were referred to a salesman/agent for Mid-West, by a friend who had recently purchased a policy through him. After our meeting and having him lay out the details of the plan, it seemed obvious that many aspects of this plan were superior to what we had at close to the same cost. We applied, were accepted and also joining, at an additional cost the association, which was Alliance for Affordable Services which supposedly gave us our group status and rates, and have had this policy since and to date.
Since we have had this policy, we have not suffered any catastrophic or serious medical issues. Emergency room visits, colds, flues, etc., just the normal with 3 active kids, but no major surgeries, serious illnesses, etc. Nearly 8 years have passed, and our premiums have steadily gone up to the point where I am now paying nearly $900 per month. A copy of our last bill is included. Several months ago, I started experiencing severe back pain. I have had back pain in the past, but this was on a more intense level. I did what we have always done, and that is to take the conservative approach, rest, back exercise, chiropractor visits, etc., all of which were paid out of pocket.
The pain was bad, but I could deal with it, then both feet and lower legs started tingling and going numb. I had never had this happen before and thought it would go away, but it did not, in fact the symptoms were and are getting worse. My chiropractor, seeing that his treatment was not helping, referred me to a neurologist, who ordered an MRI and x-rays of my back. The MRI revealed severe spinal stenosis on 3 levels, a couple of collapsed disks and arthritis which caused pressure and pinching of the nerves, resulting in the pain and numbness. Time is of the essence when there is a condition like this, as the numbness and lack of feeling, or worse, will result if not treated.
The doctor advised that I could try cortisone shot first to possibly reduce the inflammation, but that it apparent surgery (I have 3 other opinions, paid for out of pocket) would be needed soon. This was set up through the doctor and I then called Mid-West Life to verify coverage and get pre-approval for the shot.in checking what my out of pocket costs would be for this, I was informed that I would have to pay a $1500 deductible per admittance, not per occurrence. This meant that I first paid the deductible for the MRI, now I pay the deductable for the shot, (shot must be done in a surgical center under x-ray machine, the cost quoted me was about $3000), then the deductable for the surgery and any other admittance resulting from the original diagnosis.
I was shocked to find that what they were telling me about my coverage, or shall I say lack thereof. I called back several times, as I thought the representatives I had spoken too must be mistaken in what they were telling me. The explanations of my coverage differed from rep to rep, depending on who I spoke with. I then contacted the salesman/agent we had originally purchased the policy through and was left speechless when he verified the lack of coverage I had. I could not believe the risk my family and I had been in all these years, paying dearly for what we thought was good coverage, and never once was mention made by our salesman/agent or Mid-West that we might have a big problem should a serious medical need arise. When comparing what we have been paying for this worthless policy to a current Blue Cross or comparable offering, there is no comparison. The salesman/agent did comment when I spoke with him last that we did have a very old policy, one that has long since gone away. I suspect this policy may have gone away due to the numerous cases of fraud, bankruptcies, etc., associated with this company and easily found with some basic internet research. If this policy had been terminated and was out of date, why had they not let me know and offered me whatever their current offerings were?
I called Mid-West about getting a pre-approval for the shot, as this was what we had always been advised to do with our previous insurance company prior to treatment to make sure there would be coverage. I was told by Mid-West reps to submit the bill once I had received it to see what they would cover, but that they did not do pre-approvals. This means you have no idea going into it if they will cover ANYTHING! They can simply tell you after it is done that there is no coverage for your surgery and let you work your bankruptcy out yourself
In other words, this could be a $25,000 - $50,000 surgery if done at an outpatient facility, and the coverage from Mid-West, even if paid to the maximum extent of the policies coverage is almost nothing. To be exact, and this was the greatest shock of all, they would cover up to 80% of $6,000 for the surgeon and up to 80% of $2,700 for the facility and anesthesiologist. That is it, period, for outpatient surgery, and this is after the $1500 deductable is met for each admittance.in todays world this amounts to nothing. The coverage for inpatient care was not much better. All other policies I have looked at since I became aware of the situation we are in have a max out of pocket. This policy has no such thing. Had any of us been admitted to a hospital we would probably be out in the streets today. There is virtually no coverage for anything of a more serious nature.
In the event of a serious medical problem, the best case scenario would leave you with only the nearly non-existent maximum policy benefit or perhaps, at their choosing, nothing at all. This in no way, shape or form is the peace of mind I thought I was paying so dearly for. What was represented to me then is not what we have (or lack thereof) now in this policy.
First, Mid-Wests game only works as long as you dont have a serious medical need. If you do, the game is over real quick. Here is how their game works: You cant get a pre-approval, so when most medical billing people call to verify coverage, they get no verification of what is covered. Who is going to accept you for medical care if they have no verification you insurance company will pay for anything?
To quote some of the office managers of the different doctors I have been dealing with who have called and spoken to Mid-West regarding my coverage, this company is a rip off and a fraud, with rip off and fraud being the most commonly used phrases. One office manager who deals with insurance companies every day told me in the 14 years she had been doing this, she has never experienced a worse company than Mid-West Life. Another told me they could get no verification from MidWest of coverage for me. She was told they would not give her that information. They, therefore, could offer me no services.
How in the world are they allowed to continue to operate when conducting business in such a crooked and shoddy way? How many people like me and my family have they led down the path to financial ruin? In 2002 when I purchased this Mid-West policy, we had 3 young children, were and are still are self employed, and were assured these coverage were superior to the Blue Cross policy we were replacing. I am now in a position where, due to the MRI and diagnosis, I have a pre-existing condition and am virtually un-insurable through any conventional means. I have a family that is for all intent and purposes, uninsured at this time.
I have met with a friend and agent who represents several health insurance companies. We have looked at all the options and there are no good ones in this situation. I took his advice and applied for a family policy through Blue Cross. He said I will without doubt be denied and classified high risk, but the best case scenario would be that some or all of the rest of my family be accepted. This will take time.in the mean time, I am aware of the high risk insurance pool available to California resident who have been denied coverage by an insurance company. If I could get into this program, the costs would be extremely high, exceeding what I am now paying for the entire family. There is a long waiting list to get in as well, several months last time I checked with no guarantee that you will get in. Waiting 1-3 months for a denial of coverage from Blue Cross and then applying through the high risk pool, even if I could afford it, and even if there was availability would take many months, and that is the best case scenario.
I am in need of help quickly or irreversible nerve damage will result. We have been absolutely lied to ripped off and mislead with this worthless policy, slick sales person and unethical company, Mid-West National Life Insurance Co. Of TN. I am paying nearly $900 per month for this sad joke of a policy, have virtually no health insurance for my family or myself, have a serious medical condition in need of treatment quickly and now have a pre-existing condition which prevents me from purchasing another plan. This is what I have worked hard all my life and paid my bills, taxes, medical insurance etc., to end up with?
I have canceled my appointment for the needed shot and any further treatment, as I cant afford it. I just dont know where to go from here. I ask that you look into this matter and see what can be done, and to take action to prevent this company and their representatives from continuing their deceptive and destructive business practices.
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